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05/10/2008 09:54 916446: MATT PAGE 01 <br /> DATER CEIVED SAN JOAQUIN COUNTY EHD LOG NUMBER <br /> ® ENVIRONMENTAL HEALTH DEPARTMENT `34R) ,.f <br /> 1 600 East Main Street, Stockton, CA 95202-3029 � �X_)i <br /> t Telephone: (209)4138-3420 Fax: (209)464-0138 Web:wwwsjgov.org/e d <br /> 0 'yz � zoos <br /> �1 /PUBLIC RECORDS RELEASE APPLICATION _ <br /> APPLICANT: EIUSINESSIAOENCY: DF-Lm LTH <br /> ADDRESS: '27-it v.g -4�-JU W/9-/ .5,�CIJ4M1Eni,'o c14- �elf - FCEg <br /> PHONE 01: q 16 4" 3??u:5 PHONE(2): FACSIMILE: <br /> TENTATIVE'APPOINTMENT DATE: 5-Z.9-off Time: q 3v R^1 <br /> (Please allow,ton business days from date of application Submittal-•Temative only-must be confirmed} <br /> CHECK BOX TO EXPEDITE REQUEST-Sa OD FEE ASH OR CHECK ONLY)-REQUEST PROCESSED IN THREE BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> Electronic Information: ❑ List❑Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City _— I ©Unit t <br /> 1. 130 Wi00-1 WV 5 - 5r0«r70r% 0 twl , <br /> ix <br /> 2. 1160 W. Y05p,41 fiva"LuF_ MAN—.Ecq od IAt Fi(:A p 0Unit 2 <br /> z 1513 L_ (J14Z7 EQ W 9Y 5-mckTon1 3 <br /> wk) 065 A,04 II <br /> 4. ) Wq `F_4Ld0 (Z&qt7 S 0CC�IC_(0.1 Unna { 1� <br /> 61 <br /> P2Ell Us /CT V! DnH4 <br /> e. _ 11.920ir1 - WHY �Jr� h ,thNrpE5,141 (Q ha � is <br /> 9 tc015p11/gY <br /> 10. o Unit$ <br /> Specific Date Range of Information Requested:From t-L to P2t5&j, <br /> ),,r ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> )IITANK(UST) <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP( ❑HOUSING ABATEMENT ❑$OLID WASTE FACILITYWERICLE <br /> XOTHER CLEANUP Mn(NON-LOP) ElFDODFAOIUTY 0WASTE TIRE <br /> X UNDERGROUNO TANK(MONITORINGTREMOVAL) ❑DOG KENNEL ❑DAIRY3 � <br /> Un I L <br /> •HAZARDOUS WASTE GENERATOR 0 CHICKEN RANCH 0 WASTEWATER TREATMENT P NT ,�I <br /> ,�fTIERED PERMITTED FACILITY OMOTELIHOTEL O PUMPER TRUCKIYARD/CNEM TOILETS /2Z)0,60 <br /> TATIOOISODY PIERCING 0POpU$PAin <br /> O MEDICAL WASTE FACILITY O OTHER(PLEASE SPECIFY)fVX/wf`^il LLTDN ESf <br /> .7 17«E <br /> WELL ANDSePnc PERMIT RECORDS ARE AVAILABLE FOR REVIEw -MONDAY-FRIDAY 8:00 AM-6:00M- EXCLUDING HOLIDAYS. <br /> 1- List up to ten addresses in the space above. Select the type(s)of flies from the list above by checking the appropriate <br /> box(es). At least one file type MUST be selected. Fax to(209)4$4-0139 or mail to the above address. Address ranges will <br /> not be accepted-for additional assistance with file addresses,contact the EHD- Applications received after 3:00 pm will <br /> be processed the next business day. <br /> 2. The EHD will notify the applicant if any EHD flies exist. An appointment for review will be confirmed approximately telt <br /> days atter receipt of application. The files will he held for a maximum of five business days for review. Appointments <br /> should be scheduled accordingly. <br /> 3. A file that is actively being worked on by the EHD staff may not be Immediately available for review. A new application <br /> may be submitted when the file is available. <br /> 4. Any file not returned in the some Condition as released will be reorganized by EHD staff at the expense of the applicant. <br /> Future file reviews by the same applicant may require a$98.00 deposit prior to review. <br /> EHD USE ONLY <br /> VS'( Ko <br /> [Noun lwrylW PDeLIC RECORDS RELEASE APP FORM <br />